Non-selective β-blocker (topical) Pregnancy: Contraindicated in pregnancy (listed in §4.3); should not be used unless clearly necessary. Beta-blockade signs (bradycardia, hypotension, respiratory distress, hypoglycaemia) reported in the neonate; monitor if given until delivery. Appears in breast milk — breast-feeding not recommended.

Timolol maleate

Brand names: Timoptol, Tiopex

Timolol maleate is a topical non-selective beta-adrenoceptor blocker used as eye drops to lower intraocular pressure in open-angle glaucoma and ocular hypertension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Hypertension: 10-60 mg daily (most patients controlled by 10-30 mg)

Route: Oral

Frequency: Once daily or in two divided doses; doses above 30 mg daily should be given in two equally divided doses

Max: 60 mg daily (hypertension range upper limit)

Start with the lowest possible dosage and increase slowly (e.g. once weekly) under clinical control; especially important in the elderly. Angina: 5-30 mg twice daily; start 5 mg twice daily and increase daily dose by 10 mg not more often than every 3-4 days. After myocardial infarction: 5 mg twice daily for two days, then if tolerated increase to 10 mg twice daily and maintain. Migraine prophylaxis: 10-20 mg once daily or in two divided doses. Elderly: initiate at lowest adult dose, then adjust to response. Do not discontinue abruptly in ischaemic heart disease — reduce gradually over 1-2 weeks. Paediatric: safety and efficacy in children not established; no data available. Source is the UK SPC for oral Timolol Maleate 10 mg Tablets (the openFDA label in the bundle is a dorzolamide/timolol ophthalmic combination, not the oral tablet).

Dose adjustments

Renal

Administer with caution in impaired renal function; patients with kidney (or liver) insufficiency may need a lower dosage.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to timolol or to any of the excipients
Heart failure unless adequately controlled; sinus bradycardia; heart block; sick sinus syndrome (including sino-atrial block)
Cardiogenic shock
History of bronchospasm and bronchial asthma; chronic obstructive pulmonary disease
Patients receiving monoamine oxidase inhibitors
Pregnancy
Severe peripheral vascular disease / Raynaud's disease; Prinzmetal's angina; untreated phaeochromocytoma; metabolic acidosis; hypotension

Side effects

Bradycardia; atrioventricular block; cardiac failure; palpitations
Hypotension; Raynaud's phenomenon; peripheral coldness
Dyspnoea; bronchospasm (in patients with asthma or history of asthmatic complaints); cough
Dizziness; headache; paraesthesia; somnolence; syncope
Fatigue and weakness; hypoglycaemia

Clinical monograph

How it works

By blocking beta-adrenoceptors in the ciliary epithelium it reduces the production of aqueous humour, thereby lowering intraocular pressure.

Prescribing in practice

Despite topical administration, systemic absorption can produce beta-blockade, so it is contraindicated in asthma, a history of obstructive airways disease and in bradycardia, heart block or uncontrolled heart failure.
Use with caution alongside systemic beta-blockers or other drugs that slow the heart, as additive effects can occur.
Nasolacrimal occlusion or gentle eyelid closure after instillation reduces systemic absorption.

Monitoring

Monitor intraocular pressure for treatment response and remain alert for systemic effects such as bradycardia or bronchospasm, particularly in at-risk patients.

Counselling the patient

Press gently on the inner corner of the eye and close the eyelids for a short time after instilling to limit absorption into the body.
Report wheeze, breathlessness, a slow or irregular heartbeat or unusual tiredness.
Continue using regularly as glaucoma usually causes no symptoms.

Evidence & guidelines

Topical beta-blockers are an established option for lowering intraocular pressure in glaucoma per NICE guidance, with well-recognised respiratory and cardiac contraindications.

Reference: NICE NG81; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways